Diabetes is associated with cerebrovascular but not Alzheimer's disease neuropathology

Abstract

Introduction: The relationship of diabetes to specific neuropathologic causes of dementia is incompletely understood.

Methods: We used logistic regression to evaluate the association between diabetes and infarcts, Braak neurofibrillary tangle stage, and neuritic plaque score in 2365 autopsied persons. In a subset of >1300 persons with available cognitive data, we examined the association between diabetes and cognition using Poisson regression.

Results: Diabetes increased odds of brain infarcts (odds ratio [OR] = 1.57, P < .0001), specifically lacunes (OR = 1.71, P < .0001), but not Alzheimer's disease neuropathology. Diabetes plus infarcts was associated with lower cognitive scores at end of life than infarcts or diabetes alone, and diabetes plus high level of Alzheimer's neuropathologic changes was associated with lower mini-mental state examination scores than the pathology alone.

Discussion: This study supports the conclusions that diabetes increases the risk of cerebrovascular but not Alzheimer's disease pathology, and at least some of diabetes' relationship to cognitive impairment may be modified by neuropathology.

Keywords: Alzheimer; Autopsy; Cerebrovascular; Cognition; Diabetes; Infarcts; Neuropathology.

Figure 1

Participant inclusion flow diagram a. Honolulu-Asia Aging Study (n=769), the Oregon Brain Aging Study I and II (n=77 and 32), the African American Dementia Project (n=1), the Klamath Exceptional Aging Project (n=80), the Religious Orders Study (n=555), the Memory and Aging Project at Rush University Medical Center (n=454), the Memory and Aging Project at Washington University (n=126), and the Biologically Resilient Adults in Neurological Studies (n=271).